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Increased oscillation rate may improve morcellation efficiency in HoLEP.

Cameron McClaine¹, Thomas M Shelton¹, Austen Slade¹

¹Department of Urology, Indiana University School of Medicine, Indianapolis, IN, United States.

Canadian Urological Association Journal = Journal De L'Association Des Urologues Du Canada

|November 11, 2024

Summary

Higher morcellator oscillation rates during holmium enucleation of the prostate (HoLEP) significantly increase morcellation efficiency (ME). This study suggests optimizing oscillation rate can reduce procedure time in HoLEP surgery.

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Area of Science:

Urology
Surgical Technology
Medical Devices

Background:

Holmium enucleation of the prostate (HoLEP) is a leading BPH treatment.
Tissue morcellation is a critical but time-consuming step in HoLEP.
Limited data exists on the impact of morcellator oscillation rate on efficiency.

Purpose of the Study:

To investigate the effect of morcellator oscillation rate on morcellation efficiency (ME) during HoLEP.
To compare ME between low-rate (LR) and high-rate (HR) morcellation.
To analyze secondary outcomes such as enucleation efficiency (EE) and procedure time.

Main Methods:

Retrospective review of 894 HoLEP procedures performed by two surgeons.
Morcellation performed using Wolf Piranha device; enucleation with Moses 2.0 technology.
Surgeons used distinct oscillation rates: Surgeon 1 (LR: 1500 oscillations/min), Surgeon 2 (HR: 6000 oscillations/min).

Main Results:

High oscillation rate (HR) group demonstrated significantly higher ME (12.1 g/min) compared to the low oscillation rate (LR) group (9.26 g/min).
Morcellation time was substantially shorter in the HR group (6.09 min) versus the LR group (11.3 min).
Enucleation efficiency (EE) was higher in the LR group, and ME was inversely proportional to specimen weight.

Conclusions:

Increased morcellator oscillation rate during HoLEP may decrease morcellation time and enhance ME.
Findings suggest optimizing oscillation rate is crucial for improving HoLEP efficiency.
Further multi-institutional studies are needed to validate these findings and explore ME enhancement in large prostates.